Healthcare Provider Details

I. General information

NPI: 1851717953
Provider Name (Legal Business Name): TASHA L HUMPHREYS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 02/18/2023
Certification Date: 02/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HAMPTON RD UNIT 2
EXETER NH
03833-4807
US

IV. Provider business mailing address

9 HAMPTON RD UNIT 2
EXETER NH
03833-4807
US

V. Phone/Fax

Practice location:
  • Phone: 978-225-0835
  • Fax: 603-772-6761
Mailing address:
  • Phone: 978-225-0835
  • Fax: 603-772-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number061014-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number061014-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021099543
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: